Slide 1

PREMATURITY COLLABORATIVE

POLICY WORKGROUP

July 23, 2019

4:00-5:00 PM ET

Slide 2

GENERAL HOUSEKEEPING

Please note the following: All participants will be muted on entry

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Please do not place call on hold

Use the chat box, if you would like a moderator to call on you or share your comments with

the group

Slide 3

AGENDA FOR TODAY’S MEETING

Welcome –Andrea Kane, Vice President Policy & Strategic Partnerships, Power to Decide

Deeper Dive on State Innovation to Improve Access to Contraception

• New Mexico Innovations: Eve Espey, MD, MPH, Professor and Chairperson of the Dept. of Ob/Gyn, Division of Family Planning, and Family Planning fellowship director at the University of New Mexico.

• Ohio Innovations: Angela Abenaim, Teen Pregnancy Prevention Program Coordinator of the Community Wellness Dept. at Nationwide Children’s Hospital

• Utah Innovations: Kyl Myers, PhD, MS, Director of Community Education and Partnerships for the University of Utah Family Planning Division

• Closing Business

• Upcoming meetings

• Call to Action

• Next meeting on Aug. 20th 4-5pm ET/ 1-2pm PT

Adjourn

Contraception access innovations: New Mexico

Eve Espey, MD MPH

University of New Mexico

Innovations

• New Mexico Perinatal Collaborative• Immediate postpartum LARC

• Envision New Mexico• LARC mentoring Program (LMP)

• Reproductive Health ECHO

NMPC: Immediate postpartum LARC • Immediate postpartum (IPP) LARC

limited by reimbursement and training

• NM Medicaid reimburses for IPP LARC since 2013

• Current mechanisms need improvement

(ACOG Committee Opinion 670, August 2016)

Envision NM: Larc Mentoring Project

• Funding from Legislature• $250k in FY19

• $1.1 million for FY20

• Training providers and for stocking LARC devices in the clinics (SBHCs and FQHCs) to reduce barriers to same day access and increase the number of LARC providers in the state.

Reproductive Health ECHO

• Reproductive Health ECHO

• Statewide telementoring

• Topics: Reproductive justice, LARC, oral contraceptive challenges,

………………..……………………………………………………………………………………………………………………………………..

Reaching Women in

Substance Abuse

Treatment Centers and

the Justice System with

Women’s Health Services

Angela Abenaim

Community Wellness Initiatives

Nationwide Children’s Hospital

………………..……………………………………………………………………………………………………………………………………..

Ohio Better Birth Outcomes

(OBBO)

• Collaborative dedicated to reducing the infant mortality rate in

Franklin County by improving the delivery of health care

services for women and their families using quality

improvement science to guide our work.

• OBBO consists of four hospital systems in the community,

as well as the Columbus Public Health Department and

FQHCs.

• OBBO is focused on three key initiatives:– Improving reproductive health

– Expanding access to prenatal care

– Enhancing clinical quality initiatives to help reduce prematurity

CelebrateOne Executive Committee

• Oversee 5-year plan implementation• Set priorities and seek and direct

funding of new initiatives

CelebrateOne Leadership & Lead Entity Structure

City Council/Franklin County Commissioners

Prenatal Care and Supports

Ohio Better Birth Outcomes

(OBBO)/Franklin County Family Children

First

Reproductive Health

Planning

OBBO

Perinatal Quality

OBBO/Central Ohio Hospital

Council (COHC)

Smoking Cessation

and Prevention

Ohio Department of

Medicaid

Safe Sleep

Columbus Public Health (CPH) /COHC

Neighbor-hoods

City of Columbus

Women’s Health

Franklin County Dept of Job and

Family Services/Partners

for Kids

CelebrateOne Project Director/Team

• Liaison with Executive Committee / Lead Entities• Communications /Marketing• Support for Resource Development• Report Card Development • Neighborhood/Community Engagement

Account-ability/

Report Card

Columbus Public Health

LEAD ENTITIES AND STRATEGIES

………………..……………………………………………………………………………………………………………………………………..

Reproductive Health Trends among Women in Treatment

12

Sources: CDC, Ohio Department of Health, Heil, et al, Terplan, et al, NCH / CompDrug focus group survey

Pregnant or recently pregnant, opioid users: contraception decisions, perceptions and preferences

Fischbein et al. Contraception and Reproductive Medicine (2018) 3:4 https://doi.org/10.1186/s40834-018-0056-y

CONTRACEPTION USEWOMEN’S SEXUAL HEALTH HEALTH OUTCOMES

● 77% of women 21-30 engaged

in risky sexual behavior

● Less Likely to seek prenatal

care

● Can have higher rates of HIV,

Hepatitis and STIs

● Women with SUD are less

likely to use contraception

● Condoms are the most widely

used method of contraception

● 90% of pregnancies among

opioid users are unintended

● Drug use during pregnancy

can cause complications and

potential adverse outcomes

including preterm delivery, low-

birth weight and miscarriage

………………..……………………………………………………………………………………………………………………………………..

Strategy

Offering reproductive health services in SUD

treatment is a potential way to decrease

unplanned pregnancies and improve

reproductive health of women with SUD

Robinowitz et al. Family Planning in substance abuse use disorder treatment centers:

opportunities and challenges. https://doi.org/10.1080/10826084.2016.118894

………………..……………………………………………………………………………………………………………………………………..

Unique Considerations

14

History of abuse and trauma

A patient told me where I could best draw her blood because she had

used the same site that morning to inject heroin. After blurting that out,

she said she was “ashamed” that she had said that to me. And I told her “I

could very easily be sitting on that table where you are and you could be

sitting here on my stool, don’t be ashamed”. We went on to talk about how

having an addiction doesn’t mean you are weak or unworthy. And that our

paths were more similar than different. She started to cry and told me

“that’s the nicest thing anyone has ever said to me”

………………..……………………………………………………………………………………………………………………………………..

Unique Considerations

15

Stigma and abuse from the healthcare system

• Seen as drug seeking at ER, delivery, etc

• “The Look” and feeling stigmatized when explaining

to a prenatal provider that you are on MAT

• Describing to new nurses and doctors and clinic staff

about the addiction

“nobody cares because they think I just want drugs”

………………..……………………………………………………………………………………………………………………………………..

Unique Considerations

16

Trust the substance abuse treatment providers

“They are family”

………………..……………………………………………………………………………………………………………………………………..

OBBO Formula

17

Strategy: Connect women in treatment or in the

justice system to a women’s health provider

Summary:

• Onsite medical services

• Staff Training

• Client Education

• Medical Record of Case Plan

Inclusion

• Marketing

Reduce stigma and other

barriers

Frequent staff turnover requires

multiple efforts

Standing women’s health

classes

Imperative for sustainability

Keep the services top of mind

………………..……………………………………………………………………………………………………………………………………..

………………..……………………………………………………………………………………………………………………………………..

………………..……………………………………………………………………………………………………………………………………..

OBBO Efforts

………………..……………………………………………………………………………………………………………………………………..

Lessons Learned

• Walk-ins critical

• Stress confidentiality

• Zero repercussions

• Triggers matter

• Branding matters

• One size does not fit all

………………..……………………………………………………………………………………………………………………………………..

Results

• 276 women served

• 49 LARC insertions

• Additional birth control methods

• Other needs (vaccinations, STI, Hep-A, abnormal

PAP & breast exams)

• Beginning to change social norms

………………..……………………………………………………………………………………………………………………………………..

Next Steps

• Begin partnerships with new locations

• Evaluation

• New opportunities to reach those not in treatment

………………..……………………………………………………………………………………………………………………………………..

Final Thoughts

A woman shared with us that at age 12, she was

sold by her mother (also an addict) into sex work. In

the years following that time, she had 5 children

back to back and also became an addict. Now in

treatment, she came to see us for her annual well

woman and a same-day contraceptive implant. She

said that taking care of her own health makes

her feel empowered, in control, and hopeful for

the future.

………………..……………………………………………………………………………………………………………………………………..

Thank You

Angela.Abenaim@nationwidechildrens.org

614 722 4043

© U N I V E R S I T Y O F U T A H H E A L T H

FAMILY PLANNING ELEVATED

KYL MYERS, PHD, MS | DIRECTOR, FAMILY PLANNING ELEVATED

MARCH OF DIMES POLICY WORKGROUP | JULY 23, 2019

bridging the contraceptive gap in Utah

Contraceptive Policy Work in Utah

• HER Salt Lake Contraceptive Initiative

• 2018 Utah Legislative Session

• Family Planning Elevated

• 2019 Utah Legislative Session

• Resources

Partnered with existing family planning infrastructure to

remove access barriers (staffing & stocking)

and cost barriers to all methods of contraception

in Salt Lake County

HER Salt Lake Contraceptive Initiative

7,402 received no-cost contraception

At 4 PPAU clinics

4,425 enrolled in survey arm

3 years of follow up

HER Salt Lake Impact

Sanders et. al 2018 AJPH

HERsaltlake.org

HER Salt Lake Impact

https://data.guttmacher.org/calculator

2018 Utah Legislative Session

• H.B. 12 Medicaid Family Planning Waiver

• contraceptive services for Utahns 100% FPL

• de-bundling immediate postpartum LARC

• S.B. 184 Pharmacist Dispensing Authority

• Ballot Initiative – Medicaid Expansion [Nov. 2018]

• 138% FPL

• Legislature reduced eligibility to 100% FPL le.utah.gov

Undocumented Clients

0-100% FPL 101-250% FPL +251% FPL

Contraceptive Coverage Gap

Undocumented Clients

0-100% FPL 101-250% FPL +251% FPL

Contraceptive Coverage Gap

Commercial Insurance

Undocumented Clients

0-100% FPL 101-250% FPL +251% FPL

Contraceptive Coverage Gap

Commercial InsuranceMedicaid

Undocumented Clients

0-100% FPL 101-250% FPL +251% FPL

Medicaid

Contraceptive Coverage Gap

Commercial InsuranceFamily Planning Elevated

Because everyone deserves equitable access to affordable contraception

Patients PoliciesProviders

FPEutah.org

FPEutah.org/about-fpe-cap

Contraceptive Access ProgramFPE partners with community health centers to expand access

to comprehensive contraceptive care.

Contraceptive Access Program

21,000 contraceptive clientsby the end of 2021

• 11 Community Health Organizations FPE CAP Members

• University of Utah Campus Contraceptive Initiative

• Affiliate organizations and sponsors

Family Planning Elevated Impact

2019 Utah Legislative Session

• Medicaid Family Planning Waiver 2.0

• contraceptive services for Utahns <250% FPL

le.utah.gov

Resources

• HERsaltlake.org & FPEutah.org

• Utah Women’s and Newborns Quality Collaborative (UWNQC)

+17P and IPPLARC health.utah.gov/uwnqc

• ACOG’s PCAI for IPPLARC trainings pcainitiative.acog.org

• Resource for Education on Pregnancy Planning (REPP)

FPEutah.org/for-providers

• Le.Utah.Gov | H.B. 12 (2018) | S.B. 184 (2018)

Slide 43

POLL QUESTION

Would you like to extend the Policy Workgroup meeting to an hour and 15-30 minutes instead of an hour? (Ex: 3:30-4:45 PM ET)

Slide 44

• We gathered 115 participants in Orlando, FL for our

workshop on building local birth equity collaboratives.

• Dr. Zea Malawa took us through a presentation on the

historical perspective of racism & provided tangible

examples of work her local collaborative, Expecting

Justice, is doing to address those structures and systems.

She also provided lessons on results based facilitation.

• Dr. Alexander Green provided a great primer on Implicit

Bias and what we can do to address it.

• Dr. Michael McAfee took folks through sensemaking and

focused on person, place, role for attendees. Our most

critical work is building our framework.

• We ended the day with a dynamic panel that included Rev.

Tommy Rodgers-Bethlehem Baptist Church, Abbie Gilbert-

Humana, Bernadette Kerrigan- First Year Cleveland and

Lisa Skjefte-Children’s Minnesota

EQUITY IN ACTION

GOALS & PURPOSE

GOAL: To achieve equity and

demonstrated improvements in

preterm birth

PURPOSE: To engage and

convene a wide array of

organizations, drawing on their

unique expertise to problem solve

together, create solutions and drive

improvements in preterm birth and

equity using our collective action and

shared strategy and metrics.

45

Slide 46

DRAFT FRAMEWORKRESULT: ALL MOMS & BABIES ARE HEALTHY &

THRIVE BIRTH THROUGH 1 YEAR

INDICATOR: RACIALLY DISAGGREGATED PTB RATES(We will also monitor disaggregated maternal mortality, infant mortality and birth defects)

KEY FACTORS

RACISMTOXIC

STRESS/POOR HEALTH

POVERTYENVIRONMENTAL

CONDITIONS

IMPLICIT/ EXPLICIT

BIAS

INADEQUATE ACCESS TO QUALITY HEALTHCARE

STRATEGIES TO ADDRESS FACTOR

STRATEGY A STRATEGY B

SOLUTION 1 SOLUTION 1

HOW WILL YOU SHOW UP?

1. Will you help us build this frame?

1. Help us confirm and expand our strategies to address each key factor: https://www.surveymonkey.com/r/LVLSXV5

2. Help us identify solutions for each strategy: https://www.surveymonkey.com/r/LLNR9KR

2. Where do you see yourself in this framework? Share in the chat.

1. Policy should be a solution to each of our strategies in all of our key factors. Will you help us guide this work?

2. Starting thinking about your role.

3. What other individuals and organizations do we need to reach out that play a role in this frame?

48

Slide 49

COLLABORATIVE MEETING SCHEDULE (all times are EST)

2019 Jan Feb March April May June July Aug Sept Oct Nov Dec

Full

Collaborative 13

1:00-2:30

222:00-3:30

181:00-2:30

141:00-2:30

Steering

Committee 24

12:30-2:00

111:00-2:30

291:00-2:30

912:30-

2:00

Health Equity 303:30-5:00

283:30-5:00

183:30-5:00

263:30-5:00

73:30-5:00

Clinical & Public

Health Practice30

3:30–5:00

1412:30-2:00

53:30-5:00

313:30-5:00

263:30-5:00

203:30-5:00

Policy 15 | 304-5 | 3:30

124:00-5:00

134:00-5:00

184:00-5:00

144:00-5:00

184:00-5:00

234:00-5:00

204:00-5:00

263:30-5:00

224:00-5:00

194:00-5:00

174:00-5:00

Communications

TBD

Slide 50

In the chat box, you will see a link to a brief post-meetingsurvey that will take you less than 5 minutes to complete.Your feedback is very important to us. Thank you forparticipating!

The link for the survey is: http://marchofdimes.org/workgroup

Click on the Chat icon in your toolbox to access the survey link.

ADJOURN